Project Title: Promoting Integration of Primary and Behavioral Health Care
Description: Integrating primary care services into behavioral health for adults with serious mental illness and children with serious emotional disturbance through a Community Mental Health Center that is also a Federally Qualified Health Center. Population of Focus: The populations of focus for this project are children and adolescents with serious emotional disturbance and adults with serious mental illness with physical health comorbidities. Individuals will be enrolled in AltaPointe Health Systems, Inc. (AHS) programs in Mobile, Alabama that serve these populations, Childrens Outpatient Program (COP) and Zeigler Adult Outpatient Program (ZOP). COP serves children and teens ages 3-19 with emotional and behavioral needs, and ZOP is AHSs hub for individuals with severe mental illness who reside in AHSs housing continuum. In the COP, 91% are insured through Medicaid, 3.7% insured commercially, and 4.9% indigent. African-Americans are the largest race served, making up nearly 49% of the patients with 45% being Caucasian. Just under 5% of the patients identify as Hispanic. ZOP serves a patient population with similar racial and payor breakdowns as the child patients served by COP.
Goal 1: Promote full integration and collaboration in clinical practice between primary and behavioral healthcare. Objective A: AHS will provide integrated primary care and behavioral health services to 2500 adults with serious mental health or children with serious emotional disturbance in Year 1 and 4000 annually thereafter, for a total of 6,700 patients over five years.
Objective B: Department of Mental Health (DMH) will develop a workgroup to identify policy solution(s) to capture the bundled community mental health center (CMHC) services delivered under the AHS FQHC to address the complexity of the funding environment.
Goal 2: Support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status within the population of focus. Objective A: AHS shall integrate patient centered primary care services into the Zeigler Campus Adult Outpatient Program and the Childrens Outpatient Program within four months of funding. Objective B: AHS shall secure Joint Commission Patient Centered Medical Home recognition for both sites within one year of funding.
Goal 3: Promote and offer integrated care services. Objective A: AHS will screen (and treat as needed) all patients within the population of focus for depression and substance use disorder by the end of Year 1. Objective B: AHS will implement screening protocols during Year 1 (and treat/refer as needed) for all clients for the presence of co-occurring chronic physical conditions including HIV, Hepatitis, and tuberculosis. Objective C: AHS will implement chronic disease and prevention protocols and clinical performance measures by the end of Year 1.